HIV rates rise in youth

NEWS

Published 12/06/2012

by Chuck Colbert

Singer Martha Wash, a friend and colleague of the late
Sylvester, stood with AIDS Emergency Fund Executive Director Mike Smith as a
boulder commemorating the disco singer was unveiled at the National AIDS
Memorial Grove in Golden Gate Park as part of World AIDS Day activities.
(Photo: Jane Philomen Cleland)

The number of new HIV infections in the United States
remains relatively stable, standing at about 50,000 people annually.

But HIV, the virus that causes AIDS, is on the rise among
younger Americans under the age of 25.

In fact, too many youth in the United States continue to
become infected with HIV, federal officials said. And few are tested.

Those are two key take away points from a new report out by
the Atlanta-based Centers for Disease Control and Prevention, which was released
to coincide with World AIDS Day.

Specifically, young people between the ages of 13 and 24 in
the U.S. account for more than a quarter of new HIV infections each year (26
percent) while 60 percent of these youth living with HIV are unaware they are infected,
according to the CDC's Vital Signs report, released November 27.

The most-affected youth are gay and bisexual men and African
Americans.

The analysis looked at the latest data on HIV infections,
testing, and risk behaviors among young people.

The report offers insights into what kinds of behavior are
driving the high rates of infection.

For example, young men who have sex with men – or MSM
– were more likely to report having had sex with four or more partners or
injecting illegal drugs.

In addition, among students who were currently sexually
active, young MSM were also more likely to have used alcohol or drugs before
their last sexual experience and were less likely to have used a condom.

And young MSM were also less likely to report having been
taught about HIV or AIDS in school.

A silent epidemic

Medical professionals expressed concern over the report.

"The AIDS epidemic is silent," said Dr. Kenneth H.
Mayer, medical research director of the Fenway Institute in Boston, in a phone
interview. "It may have been horrible for older people, but youth don't
know people who are very sick. They think of AIDS as a disease of old people,
and it's a manageable disease. At least that is the youthful perspective."

Mayer is also the director of HIV prevention at Boston's
Beth Israel Deaconess Hospital.

For African Americans, he said, discrimination, stigma, and
homophobia are contributing factors to increased rates of HIV infection.

"These youth are very disenfranchised from society,"
Mayer explained. "If you are a young black man, you may have been
ostracized by your family of birth, experienced racism – so there is a
lot going on in your life."

Other independent factors, he said, that account for HIV
infection among young black MSM are poverty, unemployment, being a bottom
(receptive in anal intercourse), and having other sexually transmitted
diseases.

"The economic factors that make more people susceptible
to HIV speak to the fact that there is a whole set of structural issues that
place young, urban, disenfranchised youth at risk for HIV," he said.

Indeed, the increased infection rates are worrisome for AIDS
activists and service providers. Rebecca Haag, president and CEO of
Boston-based AIDS Action Committee, offered an assessment concerning the report's
findings.

"The CDC report is quite disturbing, but it doesn't
really tell us anything that we did not already know. Young people,
particularly young black and African American gay and bisexual men, are
incredibly vulnerable to HIV infection and more than half of those who are
infected with HIV are unaware of it. This is the perfect storm for spreading
HIV," she said.

Haag was referring to the results of an earlier study,
released this summer during the International AIDS Conference, which showed gay,
bisexual, and black men between the ages of 18 to 30 are infected at a rate
nearly three times more than whites.

The study enrolled more than 1,500 black, gay, and bisexual
MSM, between 2009 and 2011, from six cities, including Atlanta, Boston, Los Angeles,
New York, San Francisco, and Washington.

Mayer was a leader of the study.

Haag continued, "The CDC report calls for more
community- and school-based interventions to help stop the spread of HIV among
young people. We already know that this is what needs to happen. We've been
doing this work for years and we continue to do it. But it is unconscionable
that we do not have comprehensive sexuality education in every school.

"Our young people should know everything they need to
know about how they can keep themselves safer from HIV infection. In order to
end the AIDS epidemic, we need to employ every public health tool available to
us to reduce new infections, and that includes educating those vulnerable to
infection on ways to keep themselves safer," Haag added.

Overall, an estimated 12,200 new HIV infections in the U.S.
occurred in 2010 among young people aged 13-24, with young gay and bisexual men
and African-Americans hit harder by HIV than their peers. In 2010, for example,
72 percent of estimated new HIV infections in young people occurred in young
men who have sex with men.

By race and ethnicity, 57 percent of estimated new
infections in this age group were in African Americans.

Dr. Kenneth H. Mayer of the Fenway Institute (Photo: Bob
Roehr)

Two data sources were used for HIV testing and risk behavior
analysis, including surveys from public school students in grades 9-12 in 11
states (Connecticut, Delaware, Florida, Hawaii, Illinois, Massachusetts,
Michigan, New Hampshire, Rhode Island, Vermont, and Washington) and nine large
urban school districts (Boston, Chicago, Detroit, District of Columbia, Los
Angeles, Milwaukee, New York City, San Diego, and Seattle).

"That so many young people become infected with HIV
each year is a preventable tragedy," CDC Director Dr. Thomas R. Frieden
told reporters during a conference call last week to discuss the findings.

"All young people can protect their health, avoid
contracting and transmitting the virus, and learn their HIV status," he
said. "This is our future generation and the bottom line is that every
month 1,000 youth are becoming infected with HIV."

He added, "HIV, despite the great treatments that we
have, remains an incurable infection. And the cost of care of a single patient
is approximately $400,000 over their lifetime. That means we are incurring
about $400 million in health care costs, and every year $5 billion from preventable
infections in youth."

Despite recommendations from CDC and the American Academy of
Pediatrics that call for routine HIV testing of youth in medical settings, the
Vital Signs analysis showed that 35 percent of 18-24 year olds have been tested
for HIV, while only 13 percent of high school students – and 22 percent
of sexually experienced students – have ever been tested.

"The key here for clinicians is to make it
routine," said Frieden. "It is routine screening just as we screen
adults for high cholesterol, we screen people for HIV infection."

Test then treat

Of course, testing is only the first step to treatment, which
can lead to improved patients' health if they are found to be HIV-positive, as
well as prevent them from spreading infection.

The phenomenon is known as "treatment cascade,"
which Frieden addressed during the conference call. By "improving what we
call the treatment cascade, increasing the number and proportion of people
whose infection is controlled whose viral load is suppressed, we will reduce the
risk for everyone in society," he said. "That's a critical goal for
us to work with communities, health care providers, and most importantly with
people infected with HIV so they can get the care and services they need to
live long and productive lives, be healthy, stay out of the hospital, and not
to infect other people."

Furthermore, studies have shown that people who know they
are HIV-positive are less likely to engage in risky behaviors, such as
unprotected sex and sharing needles.

"We can and must achieve a generation that is free from
HIV and AIDS," said Dr. Kevin Fenton, director of the National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the CDC.

"It will take a concerted effort at all levels across
our nation to empower all young people, especially young gay and bisexual
youth, with the tools and resources they need to protect themselves from HIV
infection," he said.

An openly gay man, Fenton, who participated in the
conference call, is stepping down from his position at the end of the year to
return to his native England. He has served as head of the CDC's HIV/AIDS
division for seven years.

Currently, an estimated 1.2 million people in the U.S. are
living with HIV.